Benefits Summary 2020-2021 - Diocese of Palm Beach
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Welcome to your Benefit Enrollment! When Can I Enroll? There are up to three times during the year when you Here’s where to find… will be able to elect or make changes to your benefits. Enrollment Process 3 The choices you make will be in effect through July 2021. Login Instructions 4 Core Group Benefits 5 Medical 6 - 10 Dental 11 Vision 12 When you’re first hired Your coverage begins on your benefit eligibility Life Insurance 13 date. This is the time to enroll in any of the plans without a qualifying event. Disability 14 - 15 Voluntary Benefits 16 - 17 Identity Theft Protection 18 Important Contacts 19 If you have a life change Certain life events like birth or adoption of a child, change in marital status, death, or loss of coverage due to no fault of your own may allow you to change your coverage during the year. You must make your requested changes and provide your supporting documentation within 30 days of the qualifying event. At Annual Enrollment Annual Enrollment is your opportunity once each year to evaluate your benefit options and make selections for the following year. Benefits selected at Annual Enrollment are effective August through July.
2020-2021 Diocese of Palm Beach Enrollment Guide Enrollment Process The Diocese of Palm Beach provides electronic enrollment through Explain My Benefits. Explain My Benefits provides eligible employees the ability to make group insurance benefit elections and changes online during the annual open enrollment, new hire orientation and qualifying events. Enrollment has never been easier. Accessible 24 hours a day, information about all of your employee benefits election options, premiums and carrier contact information are available to help you make informed decisions. You can also log into the Explain My Benefits portal at anytime to review your benefits, access carrier links, update your personal information for yourself and dependents, update your beneficiaries and process qualifying life events. How to Enroll Self-Service Visit www.explainmybenefits.com/diocese, click on the blue “Log into your benefit system” button and move through the enrollment system at your own pace. Login instructions on are page 4. Be sure to click “Checkout” at the end of the process and make note of your confirmation. If you do not receive a confirmation, you have not completed your enrollment and you will not be enrolled for in your benefits. Return to the system anytime to view your confirmation statement. Reminders Be sure to review the 2020-2021 Benefit Guide and plan summaries prior to going through the enrollment process. Be prepared by gathering dependent and beneficiary information (i.e. Social Security Numbers and Dates of Birth). 3
2020-2021 Diocese of Palm Beach Enrollment Guide Overview of Core Group Benefits Who is Eligible? Employees working at least 30 hours each work week and their eligible dependents. Some benefits are restricted offerings. Eligibility will be indicated for each benefit. Dependents An individual who meets the eligibility criteria specified below is an Eligible Dependent and is eligible for coverage under this Booklet: 1. The Covered Employee’s Spouse*. 2. The Covered Employee’s natural, newborn, Adopted, Foster, or step child(ren) (or a child for whom the Covered Employee has been court-appointed as legal guardian or legal custodian) who has not reached the end of the Calendar Year in which he or she reaches age 26 (or in the case of a Foster Child, is no longer eligible under the Foster Child Program), regardless of the dependent child’s student or marital status, financial dependency on the Covered Employee, whether the dependent child resides with the Covered Employee, or whether the dependent child is eligible for or enrolled in any other health plan. 3. The newborn child of a Covered Dependent child who has not reached the end of the Calendar Year in which he or she becomes 26. Coverage for such newborn child will automatically terminate 18 months after the birth of the newborn child. Note: If a Covered Dependent child who has reached the end of the Calendar year in which he or she becomes 26 obtains a dependent of their own (e.g., through birth or adoption) such newborn child will not be eligible for this coverage and the Covered Dependent child will also lose his or her eligibility for this coverage. It is the Covered Employee’s sole responsibility to establish that a child meets the applicable requirements for eligibility. *SPOUSE shall mean for all purposes of the Trust and each Plan of the Trust, the individual to whom the Member Participant is civilly married under a marriage covenant between a man and a woman as described in Canon 1055 of the Code of Canon Law (Codex Iuris Canonici) for the Latin Rite of the Catholic Church. Medical and Dental - Dependent children up to age 26 regardless of financial dependency, residency, student status, employment or marital status. Coverage ends the last day of the year the child turns 26.** Vision - Dependent children up to age 30 regardless of financial dependency, residency, student status, employment or marital status. Coverage ends the last day of the year the child turns 30. **A Covered Dependent child may continue coverage beyond the age of 26 (Medical ONLY under employee’s payroll deduction), provided he or she is: 1. unmarried and does not have a dependent; 2. a Florida resident or a full-time or part-time student; 3. not enrolled in any other health coverage policy or plan; and 4. not entitled to benefits under Title XVIII of the Social Security Act unless the child is a Handicapped dependent child. *Medical - For a separate monthly cost for EACH overage child: Overage Child Standard Plan - $576.30 per month Overage Child Premium Plan - $622.20 per month *Vision - Dependents will be covered under Employee & Child(ren) or Employee Family rates. This eligibility shall terminate on the last day of the Calendar Year in which the dependent child reaches age 30. Supplemental Term Life - Dependent children up to age 19 or 25, if a full-time student. Coverage ends the last day of the year the child turns 19 or 25. 5
Group Benefit - Medical Plans Florida Blue Standard Florida Blue Premium In Network Out-of-Network In Network Out-of-Network Deductible Individual $400 $600 $300 Combined w/ In-Network Family $1,200 $1,800 $900 Combined w/ In-Network Coinsurance 20% 50% 10% 30% Out of Pocket Maximum (Includes Deductible, Coinsurance, Co-pays, PAD and Rx) Individual $3,500 Combined w/ In-Network $2,500 Combined w/ In-Network Family $7,000 Combined w/ In-Network $7,500 Combined w/ In-Network Preventive Care Office Visit Covered 100% 50% Coinsurance Covered 100% 30% Coinsurance Mammograms Covered 100% Covered 100% Covered 100% Covered 100% Colonoscopy (age Covered 100% 50% Coinsurance Covered 100% 30% Coinsurance 50+) Physician Office Visit Primary Care $25 Co-pay 50% after Ded. $25 Co-pay 30% after Ded. Specialist $50 Co-pay 50% after Ded. $50 Co-pay 30% after Ded. Diagnostic Labs 20% Coinsurance 50% after Ded. 10% Coinsurance 30% after Ded. Complex Imaging $50 Co-pay 50% after Ded. $50 Co-pay 30% after Ded. Hearing Aids External hearing aids covered up to a max 20% after Ded. 50% after Ded. 10% after Ded. 30% after Ded. of $4,500 within a 36 month period Hospital Services, Urgent Care & Walk-In Clinics In-Patient Hospital Services (Out of 20% after Ded. 50% after Ded. + $500 PAD 10% after Ded. 30% after Ded. + $300 PAD Network PAD Applies) Outpatient Surgery 20% after Ded. 50% after Ded. 10% after Ded. 30% after Ded. Emergency Room 20% after Ded. + $100 PVD 20% after Ded. + $100 PVD 10% after Ded. + $50 PVD 10% after Ded. + $50 PVD (PVD Applies) Urgent Care $25 Co-pay 50% after Ded. $25 Co-pay 30% after Ded. Prescriptions Full cost at purchase and must file Full cost at purchase and must file Max Out of Pocket $50 per Rx $50 per Rx a claim for reimbursement a claim for reimbursement 30 Day Retail 30 Day Retail Generic $5 Copay $5 Copay Formulary $35 Copay $30 Copay Non-Formulary $50 Copay Full cost at purchase and must file $45 Copay Full cost at purchase and must file 90 Day Retail a claim for reimbursement 90 Day Retail a claim for reimbursement Generic $12.50 Copay $12.50 Copay Formulary $87.50 Copay $75 copay Non Formulary $125 Copay $112.50 Copay Specialty Drugs $350 Copay (30 day supply) Not Covered $200 Copay (30 day supply) Not Covered Go to www.floridablue.com to locate a network provider. Please note that your out-of-pocket costs will be more if you choose to go to an out-of-network provider. 6
Group Benefit - Medical Important Terms Insurance can sometimes sound like a foreign language. Take a moment to review the meaning of these common terms to best understand your benefit plans. Copay Deductible A flat fee you pay whenever you use certain The annual dollar amount you pay before your medical services, like a doctor visit. insurance begins paying deductible-eligible claims. Accrues toward your out-of-pocket maximum. Accrues toward your out-of-pocket maximum. Coinsurance Out-of-Pocket Maximum The percentage of covered expenses you continue to The most you will pay during the calendar year for pay after you’ve met your deductible and before you covered expenses. This includes copays, reach your out of pocket maximum. deductibles, coinsurance and prescription drugs. Accrues toward your out-of-pocket maximum. Network Balance Billing A specific group of doctors, facilities, hospitals and The amount you are billed to make up the providers who contract with the insurance plan. difference between what your out-of-network In-network providers are your lowest cost for care. provider charges and what insurance reimburses. Balance Billing is in addition to, and does not count toward your out-of- pocket maximum Semi-Monthly (24 Pay Period) Rates 18 Pay Period Rates Florida Blue Florida Blue Florida Blue Florida Blue Coverage Tier Coverage Tier Standard Plan Premium Plan Standard Plan Premium Plan Employee Only $10.50 $32.00 Employee Only $14.00 $42.67 Employee + 1 $293.00 $337.00 Employee + 1 $390.67 $449.33 Family $401.50 $451.00 Family $535.33 $601.33 10
2020-2021 Diocese of Palm Beach Enrollment Guide Group Benefit - Dental Good oral care enhances overall physical health, appearance and mental well-being. Problems with the teeth and gums are common and easily treated health problems. Keep your teeth healthy and your smile bright with the Diocese of Palm Beach dental benefit plan through Delta Dental. Delta Dental PPO Delta Dental PPO In-Network Out of Network* Calendar Year Deductible Per Individual $100 $100 Annual Plan Maximum (per individual) $1,500 $1,500 Preventative Services Oral examinations, routine cleanings, Plan pays 100% Plan pays 100% x-rays, fluoride treatment, space Deductible waived Deductible waived maintainers Basic Services Fillings, sealants, denture repairs, 80% Covered 80% Covered endodontics, periodontics, oral surgery Major Services Crowns, inlays, onlays, cast 50% Covered 50% Covered restorations, bridges, dentures Semi-Monthly 18 Pay Period Coverage Tier (24 Pay Period) Rates Rates Employee Only $0.00 $0.00 Employee + 1 $51.50 $68.67 Family $66.50 $88.67 Go to www.deltadentalins.com to locate a network PPO provider. Please note that your out-of-pocket costs may be more if you choose to go to an out-of-network provider. ***Dependent children up to age 26 regardless of financial dependency, residency, student status, employment or marital status. Coverage ends the last day of the year the child turns 26 *When you receive services from an Out of Network Dentist, the percentages in this column indicate the portion of Delta Dental’s Out of Network Dentist Fee that will be paid for those services. The Out of Network Dentist Fee may be less than what your dentist charges and you are responsible for the difference. 11
Group Benefit - Vision Regular eye examinations cannot only determine your need for corrective eyewear, but also may detect general health problems in their earliest stages. Protection for your eyes should be a major concern to everyone. Vision benefits offered through VSP. Available to all employees. WellVision Exam Focuses on your eyes and overall wellness $10 Every plan year** Prescription Glasses $25 See frames and lenses $150 allowance for a wide selection of frames Included in Frame $170 allowance for featured frame brands Prescription Every other plan year 20% off amount over your allowance Glasses Included in Single vision, lines bifocal, and lined trifocal lenses Lenses Prescription Every plan year Polycarbonate lenses for dependent children Glasses Standard progressive lenses $55 Premium progressive lenses $95 - $105 Lens Options Every plan year Custom progressive lenses $150 - $175 Average 20-25% off other lens options Contacts $150 allowance for contacts; copay does not apply Up to $60 Every plan year (instead of glasses) Contact lens exam (fitting and evaluation) Services related to diabetic eye disease, glaucoma and age- related macular degeneration (AMD). Retinal screening for Diabetic Eyecare Plus eligible members with diabetes. Limitations and coordination $20 As needed Program with medical coverage may apply. Ask your VSP doctor for details. Glasses and Sunglasses: 20% off additional glasses and sunglasses, including lens options, from any VSP doctor within 12 months of your last WellVision Exam. Extra Savings and Retinal Screening: Guaranteed pricing on retinal screening as an enhancement to your WellVision Exam. Discounts Laser Vision Correction: Average 15% off the regular price or 5% off the promotional price; discounts only availa- ble from contracted facilities. Your Coverage with Other Providers Visit vsp.com for details, if you plan to see a provider other than a VSP doctor. Exam……….up to $45 Single Vision Lenses……..up to $30 Lined Trifocal Lenses……..up to $65 Contacts……..up to $105 Frame……..up to $70 Lined Bifocal Lenses……..up to $50 Progressive Lenses……....up to $50 *Coverage with a retail chain affiliate may be different. Once your benefit is effective, visit vsp.com for details. **Plan year begins in August Semi-Monthly 18 Pay Coverage Tier (24 Pay Period) Rates Period Rates Employee Only $3.44 $4.59 Employee & Spouse $6.86 $9.15 Employee & Children $7.35 $9.79 Family $11.74 $15.65 Go to www.vsp.com to locate a network provider. Please note that your out-of-pocket costs may be more if you choose to go to an out-of-network provider. 12
2020-2021 Diocese of Palm Beach Enrollment Guide Group Benefit - Term Life Insurance Basic Term Life and AD&D The Diocese of Palm Beach provides Basic Life and AD&D Insurance through The Standard for all eligible employees at no cost to the employee. The Basic Life benefit is $25,000 and AD&D insurance benefit is $25,000. Voluntary Supplemental Term Life You also have the opportunity to purchase supplemental term life coverage for yourself, spouse and dependent children. Please note that dependent children include unmarried adopted, natural or stepchildren age 14 days to age 19 (25 is full-time student). Employee: You may purchase in $10,000 increments up to a maximum of $100,000. Spouse: You may purchase for your spouse up to 100% of your elected amount in $10,000 increments up to a maximum of $50,000. Child(ren): You may purchase for your child(ren) in $2,000 increments up to a maximum of $10,000, not to exceed 50% of your elected amount. Guaranteed Issue Employee - $50,000 Spouse - $20,000 Child(ren) - $10,000 Guaranteed Issue is only for employees enrolling within the initial eli- gibility enrollment period. Monthly Rate Per $1,000 of Life and AD&D *An Evidence of Insurability (EOI) form will be required for amounts Age Band Employee & Spouse Child(ren) over the Guaranteed Issue or if enrolling or making changes after the initial enrollment period. Coverage is subject to approval by The 0-29 $.100 $.200 Standard. 30-34 $.110 Note: Coverage reduces by 50% at age 70 35-39 $.140 40-44 $.200 Example: A 36 year old employee wants to purchase $50,000 of term life and AD&D 45-49 $.260 insurance 50-54 $.440 Coverage Amount $50,000 55-59 $.730 # of Units/$1,000 60-64 $1.04 50 (Coverage Amount/$1,000) 65-69 $1.57 Monthly Rate per $1,000 .140 70-100 $2.93 from table on left Total Monthly Premium $7.00 13
Group Benefit - Disability Long Term Disability Laity employees of the Diocese of Palm Beach are provided, at no cost to you, Long Term Disability (LTD) coverage, after one full year of employment with the Diocese. LTD coverage supplements your lost wages should you be unable to work due to an illness or injury. LTD coverage begins after missing the specific elimination period below due to a medically certified reason. Benefits are payable up to the specific benefit duration period below. Benefits may be off-set by deductible sources of income - please see your policy for details. Elimination Period: 90 Days Monthly Benefit: 60% of your monthly earnings to a maximum benefit of $3,000 Maximum Benefit Period: Under age 61 to SSNRA*, but not less than 60 months Age 61 to SSNRA*, but not less than 48 months Age 62 to SSNRA*, but not less than 42 months Age 63 to SSNRA*, but not less than 36 months Age 64 to SSNRA*, but not less than 30 months Age 65 24 months Age 66 21 months Age 67 18 months Age 68 15 months Age 69+12 months *SSNRA (Social Security Normal Retirement Age), your normal retirement age is your retirement age under the Social Security Act where retirement age depends on your year of birth. Pre-Existing Condition: Conditions you received treatment for during the three months prior to the start of the coverage are excluded for the first 12 months of coverage. 14
2020-2021 Diocese of Palm Beach Enrollment Guide Group Benefit - Disability Short Term Disability Available to Laity only. As an employee of the Diocese of Palm Beach, you are able to enroll in Short Term Disability (STD) coverage at your own expense. STD coverage supplements your lost wages should you be unable to work due to illness, injury or pregnancy. STD coverage begins after missing the specific elimination period below due to a medically certified reason. Benefits are payable up to the specific benefit duration period below. Elimination Period: 14 days Maximum Benefit Period: 11 weeks Weekly Benefit: 60% of your weekly earnings to a maximum benefit of $1,500 Cost per $10 of weekly benefit: $.130 Calculation for Total Monthly STD Cost Example: Employee as a $52,000 annual salary and wants to pur- chase short term disability Step 1 Indicate your weekly earnings $1,000 Step 2 Multiply your weekly earnings by .60 $600 Step 3 Divide amount in Step 2 by 10 (if amount in 60 Step 2 is more than $1,500 use 150) Step 4 Multiply the amount in Step 3 by the rate of $0.130 to obtain your total STD monthly $7.80 cost. 15
Voluntary Individual Benefits What are Voluntary Benefits? Voluntary Benefits are offered to strengthen your overall benefits package. You customize the benefit based on your needs and affordability. Available to all employees. • Ownership – Policies are fully portable and belong to you if you leave the Diocese, price and plan benefits remain the same • Benefits are payroll deducted • Cash benefits are paid directly to you, not to a hospital or to a doctor • Benefits are paid regardless of any other coverage you may have • Level premiums—Rates do not increase with age • Guaranteed Renewable • Designed to provide additional cash flow to assist with out of pocket medical costs and other bills The Voluntary Benefits offered are Accident and Universal Life with Long Term Care through Trustmark. Accident Plan A plan that helps pay for the unexpected expenses that can result from an accident. • On and off-the-job coverage, 24 hours per day, 7 days per week • Family coverage available • Sports related injuries covered also Just a few examples of benefit included in the plan: • Initial Doctor’s Office Visit: $200 • Hospitalization: $3,200 admission, $500 per day • Fractures: up to $15,000 • Dislocation: up to $12,000 Wellness Benefit Included: A wellness benefit is paid for routine physicals, vaccines, and health screening tests for each covered person. There is a 60-day waiting period, after initial enrollment, for this benefit. This benefit pays $50 per test per person, twice each year (maximum $100 annually per insured). Semi-Monthly (24 Pay Period) Coverage Tier 18 Pay Period Rates Rates Employee Only $8.91 $11.87 Employee & Spouse $14.76 $19.67 Employee & Children* $18.57 $24.76 Family* $24.40 $35.53 *Dependents up to age 26 can be covered. 16
2020-2021 Diocese of Palm Beach Enrollment Guide Voluntary Individual Benefits Universal Life with Long Term Care Universal Life with Long Term Care includes both a death benefit and a living benefit. • Trustmark Universal Life with Long Term Care is a permanent life insurance policy that is designed to match your needs throughout your lifetime. It pays a higher death benefit during your working years when expenses are high and you need maximum protection. • The Universal Life with Long Term Care policy is priced to remain the same cost to you until age 100. • The death benefit reduces at age 70 when the need for life insurance typically decreases. • The Living Benefit, Long Term Care never reduces and is 4% of the original death benefit per month for up to 25 months. • If you use the Long Term Care benefit, your death benefit amount does not reduce due to the Benefit Restoration feature included. • Coverage is available for spouse ($25,000) and children (child term rider). • Employee must enroll in coverage in order to cover spouse and/or children. • Available through age 64. Special Underwriting at Initial Offering Guaranteed Issue - $100,000 (Employee Only) If you waived this benefit previously, you must answer a few health questions and be approved for coverage. Rates This benefit is customized by each employee so rates vary, but can start as little as a few dollars a week. Your specific rate will be calculated for you in the electronic enrollment system. 17
Identity Theft Protection Identity theft in the United States is a major problem that continues to be on the rise. Professional protection and assistance have become important tools in fighting the identity theft epidemic. Thieves today can get a hold of your personal information from trash cans, dumpsters, stolen mail, and even shoulder surfing. Once thieves have your information, it’s a simple matter to open new fraudulent accounts and make purchases in your name. When you enroll in LifeLock, you can be confident knowing that they are available 24 hours a day, 7 days a week, and committed 100% to helping protect your information as if it were their own. LifeLock offers Proactive Protection in both of the plans offered: Benefit Elite Plan Ultimate Plan • LifeLock Identity Alert System Provides all of the benefits of the Benefit Elite Plan plus: • Lost Wallet Protection • Stolen Funds Replacement - up to $1,000,000 • Address Change Verification • Credit Card, Checking & Savings with Account Activ- • Black Market Website Surveillance ity Alerts • Live Member Service Support • Online Annual Credit Report • LifeLock Privacy Monitor • Online Annual Credit Score • Reduce Pre-Approved Credit Card Offers • Checking & Savings Account Application Alerts • Identity Restoration Support • Bank Account Takeover Alerts • Stolen Funds Replacement - up to $100,000 • Credit Inquiry Alerts • Fictitious Identity Monitoring • Online Annual Tri-Bureau Credit Reports & Scores • Court Records Scanning • Monthly Credit Score Tracking • Data Breach Notifications • File Sharing Network Searches • Investment Account Activity Alerts • Sex Offender Registry Reports • Priority Live Member Service Support $1 Million Total Service Guarantee LifeLock’s proactive approach works to help stop identity theft before it happens. As a LifeLock member, if you become a victim of identity theft because of a failure in their service, they will help fix it at their expense, up to $1,000,000. Semi-Monthly Semi-Monthly 18 Pay Period 18 Pay Period Coverage Tier (24 Pay Period) (24 Pay Period) Rates Rates Rates Rates Benefit Elite Plan Ultimate Plan (New) Employee Only $4.25 $5.66 $12.75 $17.00 Employee & Spouse $8.49 $11.32 $25.49 $33.99 *Employee & Children $7.43 $9.91 $18.06 $24.08 *Family $11.68 $15.57 $30.81 $41.08 *Employee & Children and Family Tiers: You may enroll up to 8 children with 4 of those children between the ages of 18 and 26. 18
2020-2021 Diocese of Palm Beach Enrollment Guide Important Contacts Vendor Phone Website Medical 800-345-3885 www.floridablue.com Florida Blue Pharmacy 800-771-4648 www.elixirsolutions.com Elixir Pharmacy Benefits Dental 800-521-2651 www.deltadentalins.com Delta Contact the Benefits office at the Diocese: Life / STD / LTD Sandy Maulden: smaulden@diocesepb.org The Standard 561-775-9574 Ana Jarosz: anaj@diocesepb.org 561-775-9525 Vision 800-877-7195 www.vsp.com VSP Voluntary Benefits 800-918-8877 www.trustmarksolutions.com Trustmark Identity Theft Protection 800-543-3562 www.lifelock.com LifeLock Trustmark Claims Help 321-296-8060, Option 2 service@explainmybenefits.com Explain My Benefits Sandy Maulden 561-775-9574 For other questions please contact the Diocesan Benefits Office: smaulden@diocesepb.org Or go to the website at: Ana Jarosz http://www.explainmybenefits.com/diocese 561-775-9525 anaj@diocesepb.org Fax: 561-775-9575 19
Benefit Guide Description This summary of benefits is not intended to be a complete description of the Diocese’s insurance benefit plans. Please refer to the plan document(s) for a complete description. Each plan is governed in all respects by the terms of its legal plan document, rather than by this or any other summary of the insurance benefits provided by the plan. In the event of any conflict between a summary of the plan and the official document, the official document will prevail. Although the Diocese maintains its benefit plans on an ongoing basis, the Diocese reserves the right to terminate or amend each plan in its entirety or in any part at any time. For questions regarding the information provided in this overview, please contact your Diocese human resources representative.
You can also read